- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $3,630.78 / $9,549.93
| Facility | | $281.84 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,137.96 / $5,888.44
| Facility | | $1,412.54 | $2,137.96 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $239.88 / $295.12
| Professional | | $199.53 | $239.88 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $467.74 / $537.03
| Professional | | $354.81 | $467.74 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $354.81 / $524.81
| Facility | | $229.09 | $354.81 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $331.13 / $10,000.00
| Facility | | $218.78 | $331.13 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |